Improvements In Body Mass Index Research Articles

Abstract P075: Oncologists’ Perceptions of the Usability of SPHERE: an Electronic Health Record Application Based on Life’s Simple 7™

Background: We developed SPHERE, an electronic health record (EHR) data visualization application, to automatically populate with EHR data on the American Heart Association’s cardiovascular health (CVH) behaviors and factors. SPHERE was designed to increase patient-provider communication around Life’s Simple 7™, and utilized a stoplight color scheme as part of the visualization to indicate “ideal” (green), “intermediate” (yellow), and “poor” (red) CVH. Results from the SPHERE Study showed improvements in body mass index and diabetes status among eligible patients seen in the intervention clinic as compared to the control clinic. It remains unknown whether the use of SPHERE would be acceptable to oncologists in the survivorship care setting, even though cancer survivors are at high risk for developing cardiovascular disease. Methods: We conducted one-on-one interviews, using a think-aloud protocol, with 14 oncologists (10 community practice, 4 academic) who were practicing in the NCI Community Oncology Research Program (NCORP). During the 30-minute interview period, we asked each oncologist to use SPHERE and we obtained user feedback on the SPHERE application. Results: Half of the oncologists were male, and most (78%) were medical oncologists; 2 were gynecologic oncologists, and 1 was a radiation oncologist. When asked about discussing CVH with post-treatment, good-prognosis patients, no oncologists indicated that they “never” talked to patients about CVH or initiated those discussions. Eleven oncologists responded that discussing CVH was either “somewhat important” or “very important”, and 9 oncologists indicated they were “somewhat comfortable” or “very comfortable” discussing CVH with patients. Themes identified from transcripts of the 7 hours of interviews suggest 1) strong interest in the tool, 2) high perceived importance of discussing CVH with patients who had a good prognosis, 3) high usability, and 4) a belief that the tool would be helpful and not overly burdensome in practice. Duplication of preventative health efforts with the primary care provider as well as workflow and time constraints were identified as barriers by several oncology providers. Conclusions: Overall, these preliminary data demonstrate acceptability and feasibility of implementing the SPHERE application tool within NCORP community oncology practices. These qualitative data suggest great potential for automated EHR-based applications such as SPHERE to impact the CVH of cancer patients in survivorship care.

Exploring Psychiatric Features of Patients with Long-Term Vomiting after Bariatric Surgery

Exploring Psychiatric Features of Patients with Long-Term Vomiting after Bariatric Surgery Vomiting is a common side effect of bariatric surgery, occurring in the short and long-term post-operative period. Multiple factors cause chronic vomiting in bariatric patients such as surgical complications and maladaptive eating patterns. To date, psychiatric features associated with vomiting after bariatric surgery has been poorly and not specifically investigated. We explored possible socio-demographic and psychiatric differences (age, gender, marital status, psychiatric comorbidities, impulsivity, body image dissatisfaction, binge eating, depression, quality of life) of those patients who vomit over at least the first year post-operatively compared with those without vomiting. Sixty-one participants were enrolled, 37 women and 24 men; mean age was 45.45 (SD=9.88) and mean BMI was 46.51 (SD=7.29). The “vomiting” group comprised 18 individuals with at least one weekly episode of long-term vomiting. Clinical psychiatric evaluation and psychometric assessment were performed before and one year after bariatric surgery. The “vomiting” and “non-vomiting” groups did not differ in age, gender, marital status, types of surgical procedure, and % of Excess BMI Loss. Models of rm-ANOVA revealed significant “time” (pre vs. post-surgery) effects, meaning improvement of body mass index (BMI), body dissatisfaction, depression, binge eating, impulsiveness, and quality of life after surgery; “time” × “group” (vomiting vs. non vomiting) effects were not significant, revealing no differences between “vomiting” and “non vomiting” groups. This study didn’t find a relationship between long-term vomiting and psychiatric features. Post-operative vomiting may not require psychiatric additional interventions. If the irrelevance of psychiatric mechanism will be confirmed, the identification of factors associated with vomiting which are amenable of psychological interventions, will help the improvement of the multidisciplinary approach to bariatric patients. In particular, the development of healthy eating patterns, the adherence to nutritional recommendations can benefit from a thoughtful mental health care.

Effects of Nutrition Nursing on Hemodialysis Patients with End-stage Renal Disease

Objective: To investigate the effects of nutritional nursing on hemodialysis patients with end-stage renal disease and to provide reference for clinical guidance. Methods: Sixty-eight hemodialysis patients with end-stage renal disease Admitted from February 2013 to March 2016 were randomly divided into control group (n = 34) and observation group (n = 34). In the control group, the routine nursing intervention was carried out, while the observation group was applied with the nutrition-nursing intervention on the basis of routine nursing. Nutritional status, quality of life and satisfaction of nursing were observed. Results: The improvement of body mass index and malnutrition inflammation score in the observation group were (23.6 ± 3.4) kg/m2 and (5.2 ± 0.3) points respectively, which were better than those in the control group (17.5 ± 2.3) kg/m2, (8.7 ± 0.5) min, P < 0.05. The total score of quality of life in the observation group was (71.2 ± 4.5) points, which was higher than that in the control group (P < 0.05). The total satisfaction (94.12%) of the patients in the observation group was improved when compared with the control group (P < 0.05). Conclusion: According to the characteristics of end-stage renal disease hemodialysis patients, targeted nutrition-nursing intervention can effectively improve the nutritional status of patients, promote harmonious relationship between doctors and patients and improve the quality of life. It is worth to implement and promote the nutrition nursing in the clinical care.

A case series investigation between transaminitis and the improvement in body mass index trend among patients with anorexia nervosa and eating disorder not otherwise specified of the anorexia nervosa type

Introduction: Anorexia nervosa and eating disorder not otherwise specified are eating disorders on a rising trend in Singapore. Apart from psychological aspects of the disease, many such patients suffer from serious medical complications. Liver function tests abnormalities, usually in the form of elevation of the transaminases, have been reported to occur in up to 12.2% of patients with anorexia nervosa. The paper aims to investigate the correlation of transaminitis with the improvement of body mass index (BMI) in these patients. Method: A retrospective cohort analysis of 373 patients with anorexia and eating disorder not otherwise specified at a tertiary hospital was done. The clinical course of transaminitis was correlated with the body mass index. Results: There were 32 complete data of patients with BMI with transaminitis and their corresponding BMI on resolution of transaminitis. The mean BMI on resolution of transaminitis was BMI 15.8 for these 32 patients. The statistical analysis showed that there was no significant association between BMI group and resolution of transaminitis, χ2 = 1.32, p=0.73. Conclusion: There is no significant association between improving BMI and resolution of transaminitis. Tracking of BMI is inadequate to monitor the recovery of the liver function. There is need for routine liver function test to determine improvement of the liver function.

Effect of the national lifestyle modification project conducted in Japan on the parameters of metabolic syndrome

Although the national lifestyle modification project targeting metabolic syndrome in the general population conducted by the Japanese government started in 2008, the project's long-term effects have not yet been evaluated. Associations of taking the project's lifestyle modification guidance with improvement of parameters related to metabolic syndrome after 1, 2, 3, and 4 years were assessed in participants who met the metabolic syndrome criteria for the guidance. While improvement was defined when the parameters had met the criteria for metabolic syndrome at the initial checkup but did not at the time of evaluation without medication, deterioration was defined when they had not met the criteria at the initial checkup but, at the time of evaluation, they did or the subjects received the medication. Logistic regression analyses were used to evaluate improvement by the guidance adjusted for age, sex, systolic blood pressure, HDL cholesterol level, and hemoglobin (Hb)A1c level at baseline. From 2008 to 2011, 3742 participants (mean age 61±10 years, men 62%) met the criteria for the lifestyle modification guidance. Numbers of participants eligible for evaluation were 2690, 1894, 1330, and 779 at 1, 2, 3, and 4 years after the initial checkup, respectively. Based on the multivariate logistic regression analyses, receiving the guidance was significantly associated with improvement of body mass index (BMI) (odds ratio (OR)=1.66, 95% confidence interval (CI)=1.17-2.37), waist (OR=1.77, 95%CI=1.35-2.31), and HbA1c (OR=1.82, 95%CI=1.05-3.13) at the 1-year evaluation; improvement of BMI (OR=1.51, 95%CI=1.01-2.26) and waist (OR=1.61, 95%CI=1.18-2.20) at the 2-year evaluation; and improvement of waist (OR=1.67, 95%CI=1.12-2.48) at the 3-year evaluation. However, BMI, waist, and HbA1c at other evaluations including the 4-year evaluation and the remaining parameters at any evaluations were not significantly improved by the guidance. In addition, receiving the guidance was significantly associated with deterioration of HbA1c at the 4-year evaluation (OR=2.49, 95%CI=1.18-5.24). Although HbA1c at the 1-year evaluation and parameters related to overweight were improved at the 1-, 2-, and 3-year evaluations, no parameters of metabolic syndrome were significantly improved by the guidance at the 4-year evaluation.

Allogeneic haematopoietic stem cell transplantation for mitochondrial neurogastrointestinal encephalomyopathy.

Haematopoietic stem cell transplantation has been proposed as treatment for mitochondrial neurogastrointestinal encephalomyopathy, a rare fatal autosomal recessive disease due to TYMP mutations that result in thymidine phosphorylase deficiency. We conducted a retrospective analysis of all known patients suffering from mitochondrial neurogastrointestinal encephalomyopathy who underwent allogeneic haematopoietic stem cell transplantation between 2005 and 2011. Twenty-four patients, 11 males and 13 females, median age 25 years (range 10-41 years) treated with haematopoietic stem cell transplantation from related (n = 9) or unrelated donors (n = 15) in 15 institutions worldwide were analysed for outcome and its associated factors. Overall, 9 of 24 patients (37.5%) were alive at last follow-up with a median follow-up of these surviving patients of 1430 days. Deaths were attributed to transplant in nine (including two after a second transplant due to graft failure), and to mitochondrial neurogastrointestinal encephalomyopathy in six patients. Thymidine phosphorylase activity rose from undetectable to normal levels (median 697 nmol/h/mg protein, range 262-1285) in all survivors. Seven patients (29%) who were engrafted and living more than 2 years after transplantation, showed improvement of body mass index, gastrointestinal manifestations, and peripheral neuropathy. Univariate statistical analysis demonstrated that survival was associated with two defined pre-transplant characteristics: human leukocyte antigen match (10/10 versus <10/10) and disease characteristics (liver disease, history of gastrointestinal pseudo-obstruction or both). Allogeneic haematopoietic stem cell transplantation can restore thymidine phosphorylase enzyme function in patients with mitochondrial neurogastrointestinal encephalomyopathy and improve clinical manifestations of mitochondrial neurogastrointestinal encephalomyopathy in the long term. Allogeneic haematopoietic stem cell transplantation should be considered for selected patients with an optimal donor.

Evaluation of the effects of a telephone‐delivered health behaviour change program on weight and physical activity

AbstractAimTelephone health behaviour change interventions have shown potential as a medium for change. The aim of the present study was to evaluate the effectiveness of a telephone behaviour change program on weight and physical activity. It was hypothesised that participants would achieve significant improvements in body mass index (BMI) and physical activity at the completion of the program and at follow up.MethodsA six‐month health telephone behaviour change program was delivered by health professionals trained in health coaching methodology. Participants (n = 250) had two or more chronic disease risks, received five calls during the program and a follow up call 12–18 months after completion of the program.ResultsThe average participant age was 70, 72% were female and mean BMI was 28.90 kg/m2. Significant improvements in BMI were reported from baseline to post‐intervention (−1.70% change) and from baseline to follow up (−1.21% change). Changes in weight were significant from baseline to post‐intervention (−1.67% change) and not significant from baseline to follow up (−1.25% change). Significant changes in the average number of minutes spent in moderate to vigorous intensity physical activity (MVPA) per week were reported between baseline and post‐intervention and post‐intervention and follow up. From baseline to follow up, the average time spent in MVPA per week increased by 157 minutes. At follow up, 86% of participants maintained or further improved their health behaviour.ConclusionsThe present study demonstrated the potential effectiveness of a low‐dose telephone health behaviour change program in assisting participants to change and maintain their health behaviour.

Combined Medical Treatment Of Chronic Pancreatitis

Abstract The aim of the study was to determine the most effective medical treatment of patients with chronic pancreatitis, by using either pancreatin alone or in combination with proton pump inhibitor (PPI) or PPI and non-steroidal anti-inflammatory drug (NSAID). Patients with chronic pancreatitis, who did not require a surgical treatment, received medical treatment for a one–month period: 20 patients received pancreatin monotherapy; 48 patients were given a combination of pancreatin and PPI; 38 patients were treated with a combination of pancreatin, PPI and NSAID (PNP therapy group). In comparison with other groups, patients in the PNP therapy group showed improvement in body mass index, abdominal pain, bowel movements, chronic pancreatitis severity, as well as their quality of life assessment (p &lt; 0.05). The combination of pancreatin, PPI and NSAID was the most effective among those applied in chronic pancreatitis patient treatment. A one–month long course of this therapy was safe and did not cause any significant adverse effects. The combination of pancreatin, PPI and NSAID for treatment of chronic pancreatitis can be recommended, as it is based on pathogenesis of the disease, effective, safe and economically advantageous.

A case series investigation of association between co-morbid psychiatric disorder and the improvement in body mass index among patients with anorexia nervosa and eating disorder not otherwise specified of the anorexia nervosa type.

BackgroundAnorexia nervosa and eating disorder not otherwise specified* (not fulfilling Anorexia Nervosa DSM IV criteria) are increasing in Singapore. Patients with eating disorders may also present with other psychiatric disorders such as depression and anxiety. The paper aims to investigate the association of co-morbid psychiatric disorders with the improvement of body mass index (BMI) in these patients.MethodsA retrospective cohort analysis of 182 patients with anorexia and eating disorder not otherwise specified at a tertiary hospital was done. The clinical course of co-morbid psychiatric disorders was correlated with the improvement of body mass index.Results109 patients were included in the analysis and the mean BMI on resolution of co-morbid psychiatric disorders was BMI 16.9. There is a significant association between the BMI groups and the resolution of co-morbid psychiatric disorders, χ2 = 10.2, p = .03. Patients in BMI group 5 (BMI 16.6 - 18.5) were noted to be significantly less likely to resolve their psychiatric co-morbidity compared to the other 4 groups. (OR = 0.323).ConclusionPatients with anorexia nervosa and eating disorders not otherwise specified were at increased risk of having co-morbid psychiatric disorders and the clinical course of co-morbid psychiatric disorders appeared to correlate with improved BMI. Specifically patients with BMI < 16.5 with co-morbid psychiatric disorders were more likely to recover from their co-morbid psychiatric disorder with nutritional rehabilitation than patients with a higher BMI.

Determinates of Regain in Body Mass Index among Malnourished Aids Patients on Therapeutic Food in Amhara National Regional State, Northwest Ethiopia: A Retrospective Cohort Study

Although its utilization is greatly disputed, ready-to-use therapeutic food has been started as clinical nutrition care and treatment for malnourished adult AIDS patients since 2011 in Amhara National Regional State. However, factors determining the intended outcome (weight gain) have not been properly investigated. The main objective of the study was to assess improvement in body mass index and to identify its determinant factors. A retrospective cohort study design was conducted. Cluster sampling was employed to select health facilities in which the service was provided in the region. Of the 44 health facilities, nine were selected using lottery method, and all patients receiving the care in these health institutions were included in the study. Using tailored structured checklist, data were collected, organized and cleaned. Using paired T-test existence of difference between the mean of body mass index at admission and at 3rd visit was measured. Finally analysis of association between some selected independent variables with the outcome variable was done using logistic regression model at 95% CI and p 2). Paired T-test revealed that there was a statistically significant difference between mean of body mass index at admission and at the 3rd visit. Good ready-to-use therapeutic food treatment adherence (AOR 11.145; 95% CI 6.556, 18.946), moderate acute malnutrition at admission (AOR 6.71; 95% CI 2.618, 17.195), good ART adherence (AOR 2.136; 95% CI, 1.269, 3.595) and being male (AOR 1.73; 95% CI 1.052, 2.850) have a statistically significant contribution for body mass index improvement. The study identifies factors that determine gain in body mass index among AIDS patients on ready-to-use therapeutic food. However, although the study revealed a statistically significant difference between body mass index during enrolment, and after three months, we disagreed with the right and left utilization of imported food because of lack of sustainability, and aid dependency. We rather recommend interventions that encourage households to produce food with similar outcomes from locally available food staff.

Anthropometric and biochemical profile of children and adolescents with chronic kidney disease in a predialysis pediatric interdisciplinary program.

This is longitudinal retrospective observational cohort study that evaluated anthropometric and biochemical variables of children and adolescents admitted to a Predialysis Interdisciplinary Management Program (PDIMP) responsible for the follow-up of children and adolescents at stages 2 to 4 of chronic kidney disease (CKD) at a tertiary center. One hundred thirty-eight patients with CKD on predialysis treatment with median age at admission of 9 years and the median follow-up time of 5 years were evaluated. Seventy-four (53%) had CKD stage 3 at admission and 70 (51%) reached CKD stage 5 at the end of the follow-up. There was no significant difference between the mean initial and final hemoglobin and serum albumin. However, the final serum bicarbonate presented a significant improvement. Analyses stratified according to clinical variables of interest showed a significant improvement in body mass index (BMI) Z score, especially in the subgroup of children admitted under two years of age. In relation to stature-for-age Z score, data show a significant improvement in stature SD at the end of the study. In conclusion, the present study showed improvement of nutritional status of CKD patients and that the deterioration of renal function was not correlated with BMI-for-age Z score.

Bariatric surgery improves the circulating numbers and biological activity of late outgrowth endothelial progenitor cells

BackgroundAlthough the salutary effects of bariatric surgery as a treatment for excess weight and type 2 diabetes are established, there is scant evidence for effects on other contributors to cardiovascular diseases such as repair of endothelial dysfunction. This study evaluates outcomes of bariatric surgery on late outgrowth endothelial progenitor cells (LOEPCs), a cell phenotype essential for endothelial repair. MethodsPatients with a body mass index >35 kg/m2 and type 2 diabetes were enrolled into either medical or bariatric surgical arms. Primary outcomes included analysis of isolated LOEPCs from peripheral blood for growth, function, and mitochondrial respiration. Plasma was used for metabolic profiling. ResultsMedical arm patients showed no improvement in any of the parameters tested. Bariatric surgical arm patients showed a 24% reduction in body mass index as early as 3 months postintervention and resolution of type 2 diabetes at 24 months postintervention (HbA1c 31% reduction; fasting glucose 29% reduction). Bariatric surgery increased the numbers of LOEPCs 8-fold and increased LOEPC network formation 3-fold at 24 months postintervention. The increased numbers and activity of LOEPCs in the bariatric surgical arm correlated with improvements in body mass index, insulin, and triglyceride levels only at 24 month postintervention. LOEPC mitochondrial respiration displayed a trend toward improvement compared with baseline as evidenced by an increase (36%) at 24 months in the bariatric arm. ConclusionBariatric surgery increases LOEPC levels and activity, which correlates with weight loss and improved metabolic profile at 24 months postintervention.

Improvement in taste sensitivity following pulmonary rehabilitation in patients with chronic obstructive pulmonary disease.

Weight loss is common in patients with chronic obstructive pulmonary disease (COPD). Anorexia, postulated to be associated with alteration in taste sensitivity, may contribute to weight loss in these patients. Pulmonary rehabilitation is known to lead to improved exercise performance in patients with COPD. However, the relationship between pulmonary rehabilitation and taste sensitivity has not been evaluated. The objective of this study was to compare taste sensitivity before and after pulmonary rehabilitation in patients with COPD. Single-group intervention trial. Twenty-two patients with COPD. The six-min walk distance (6MWD), COPD assessment test, body mass index, fat mass index, fat-free mass index and taste test were conducted before and after 4-week pulmonary rehabilitation. Taste sensitivity was evaluated using the filter-paper disc method for 4 taste stimuli. Taste stimuli were salty, sweet, sour, and bitter tastes. Taste sensitivity was evaluated before and after pulmonary rehabilitation using the taste recognition threshold. Following pulmonary rehabilitation, the 6MWD, COPD assessment test, salty recognition threshold, sweet recognition threshold and bitter recognition threshold improved significantly, whereas there were no significant improvements in body mass index, fat mass index, fat-free mass index or sour recognition threshold. Pulmonary rehabilitation may improve taste sensitivity in patients with COPD.

Cardiac rehabilitation with a nurse case manager (GoHeart) across local and regional health authorities improves risk factors, self-care and psychosocial outcomes. A one-year follow-up study

ObjectivesIn Denmark, the local and regional health authorities share responsibility for cardiac rehabilitation (CR). The objective was to assess effectiveness of CR across sectors coordinated by a nurse case manager (NCM).DesignA one-year follow-up study.SettingA CR programme (GoHeart) was evaluated in a cohort at Lillebaelt Hospital Vejle, DK from 2010 to 2011.ParticipantsConsecutive patients admitted to CR were included. The inclusion criteria were the event of acute myocardial infarction or stable angina and invasive revascularization (left ventricular ejection fraction (LVEF) ≥45%).Main outcome measuresCardiac risk factors, stratified self-care and self-reported psychosocial factors (SF12 and Hospital Anxiety and Depression Scale (HADS)) were assessed at admission (phase IIa), at three months at discharge (phase IIb) and at one-year follow-up (phase III). Intention-to-treat and predefined subgroup analysis on sex was performed.ResultsOf 241 patients, 183 (75.9%) were included (mean age 63.8 years). At discharge improvements were found in total-cholesterol (p < 0.001), low density lipoprotein (LDL; p < 0.001), functional capacities (metabolic equivalent of tasks (METS), p < 0.01), self-care management (p < 0.001), Health status Short Form 12 version (SF12; physical; p < 0.001 and mental; p < 0.01) and in depression symptoms (p < 0.01). At one-year follow-up these outcomes were maintained; additionally there was improvement in body mass index (BMI; p < 0.05), and high density lipoprotein (HDL; p < 0.05). There were no sex differences.ConclusionCR shared between local and regional health authorities led by a NCM (GoHeart) improves risk factors, self-care and psychosocial factors. Further improvements in most variables were at one-year follow-up.

Trends in New U.S. Marine Corps Accessions During the Recent Conflicts in Iraq and Afghanistan

The objective of this study was to analyze trends in preservice characteristics among Marine Corps recruits during the recent operations in Iraq and Afghanistan. Recruits completed a confidential survey during their first week of training at the Marine Corps Recruit Depot in San Diego, California. Demographics, behaviors, and health information were analyzed for trends from 2001 to 2010 using the Cochran-Armitage trend test and F statistic. Data from 131,961 male recruits with a mean age of 19.8 years were analyzed. Overall, entry characteristics remained stable exhibiting only modest changes over the study period. Favorable trends included recent (2009-2010) improvements in body mass index and physical activity levels. Unfavorable trends included increases in smokeless tobacco and caffeine use, and angry outbursts. Although many recruit characteristics remained similar over the past decade, both favorable and unfavorable trends in sociobehavioral characteristics were noted. The ongoing assessment of preservice characteristics is important for detecting emerging trends over time. Findings may guide leadership's understanding of changes to help develop early-service trainings promoting a healthier force and potentially reducing future adverse outcomes.

The efficacy of a self-management programme for people with diabetes, after a special training programme for healthcare workers in Taiwan: a quasi-experimental design

To analyse the efficacy of improving disease management after implementing a self-management programme for people with type 2 diabetes administered by healthcare workers who have received special training. The needs for diabetic care include increased training for healthcare providers to enhance their confidence and skills in managing patients, both physically and mentally. Quasi-experimental design. This study recruited participants from outpatient clinics in 10 hospitals in Taiwan. In 2010, purposive sampling was used to recruit 228 participants from two medical centres, five regional hospitals and three district hospitals. Participants were enrolled in a 'diabetes self-management programme' (watching patient videos, reading a diabetes self-care handbook, participating in four consultation courses of diabetes self-efficacy improvement, telephone follow-up and positive reinforcement). Efficacy analysis of post-test diabetes outcome variables of the experimental group was carried out. Sex, age and pretest score were used as the control variables for ancova test. Patients in the experimental group had significant improvement in body mass index (p<0·01), waistline circumference (p<0·001), haemoglobin A1C levels (p<0·001), degrees of anxiety and depression (p<0·001), self-efficacy (p<0·001) and levels of self-care (p<0·001). Self-efficacy of people with diabetes can be effectively improved by planned implementation of a 'diabetes self-management programme' by trained healthcare workers. The diabetes care professionals are provided the self-management programme to strengthen the awareness and importance of self-management in diabetes care.

Randomized, Vitamin E-Controlled Trial of Bicyclol Plus Metformin in Non-Alcoholic Fatty Liver Disease Patients with Impaired Fasting Glucose

Non-alcoholic fatty liver disease (NAFLD) is associated with a high morbidity in patients with impaired fasting glucose (IFG). Bicyclol is a synthetic compound known to protect the liver against oxidation and lipid injuries. The objective of this study was to evaluate the efficacy and safety of metformin and bicyclol in the treatment of NAFLD patients with IFG. After lifestyle changes and metformin treatment (500 mg orally three times daily), the 248 patients enrolled with NAFLD and IFG were equally randomized to two 24-week treatment groups: bicyclol 25 mg three times daily or vitamin E (α-tocopherol) 100 mg three times daily (control). Anthropometric measurements, serum biochemistry, liver/spleen computed tomography ratio, and changes in liver histological parameters were compared before and after treatments. A total of 223 patients completed the treatment, and there were significant improvements in body mass index, waist-to-hip ratio, and biochemical parameters in both groups (P < 0.01). Compared with the control group, the improvement in serum alanine aminotransferase levels in the bicyclol group was statistically significant (P < 0.01). Liver histological assessments revealed that steatosis, inflammation, hepatocellular ballooning, and NAFLD activity scores (NAS) were all decreased in both groups after treatment (P < 0.01). However, decreases in inflammation and NAS in the bicyclol group were statistically significant compared with the vitamin E group (P < 0.01). Adverse events in the bicyclol and control groups occurred in 1.79 and 1.80 %, respectively. Metformin combined with bicyclol is effective and safe in the treatment of patients with NAFLD and IFG. However, further studies with a larger sample size are needed to confirm the efficacy and safety of the combination.

Metabolic syndrome associated with hyperprolactinemia: A new indication for dopamine agonist treatment?

In this issue of Endocrine, Inancli and co-authors presentthe manuscript ‘‘Effect of cabergoline on insulin sensitivity,inflammation, and carotid intima media thickness inpatients with prolactinoma’’ [1]. They found that cabergo-line treatment was associated with significant improve-ments in body mass index; total, HDL, and LDL-cholesterollevels and insulin sensitivity, also with a decrease in pro-inflammatory markers and carotid intima media thickness.Only the decrease in total and LDL-cholesterol showed apositive correlation with PRL levels. They concluded thatpatients with prolactinoma may have a higher vascular riskand cabergoline treatment may be associated with betterendothelial function [1].The human prolactin (PRL) is mainly produced bypituitary lactotrophs under inhibitory control of hypotha-lamic dopamine. The main and best-known effect of thePRL is the stimulation of lactogenesis and the maintenanceof lactation (galactopoiesis). However, PRL is also syn-thetized in extra-pituitary sites (decidua, myometrium,lymphocytes, and adipocytes) exerting several functions asa ‘‘metabolic hormone’’ [2–4].The human PRL gene is located on chromosome 6, hassix exons and two transcriptional start sites for extra-pitu-itary and for pituitary PRL. The regulation of PRL genetranscription is also different, requiring interaction withPit-1 at pituitary level and with several not well-knowntissue-specific factors for each extra-pituitary site [4].However, the final protein, PRL, is the same at pituitaryand extra-pituitary sites. In contrast with the pituitary PRLsecretion, the regulation of PRL extra-pituitary secretion islargely unknown.The PRL receptor is widely expressed in human bodyand mediates PRL actions by activation of JAK2/STAT5,PI3K, and MAPK pathways [4]. Regardless of its origin,PRL is able to interact with PRL receptors of any bodylocation. However, the mechanisms regulating the expres-sion of PRL receptor (and its different isoforms) in eachextra-pituitary tissue are basically unknown. This complexsystem could explain the absence of relationship betweencirculating PRL levels and some of the metabolic effects(mainly autocrine or paracrine) of PRL.The metabolic (extra-mammary gland) effects of PRLhave been reviewed elsewhere [2–5] and can be summa-rized as follows: (a) during the perinatal and postnatalperiods pancreatic islet cells development and insulinsecretion are promoted; (b) food intake and weight gainare also promoted; (c) adipogenesis inhibiting lipolysis isstimulated, which alters the release of adipokines includingleptin, adiponectin, and inter-leukin 6, promoting insulinresistance, hyper insulinemia, endothelial dysfunction, andmetabolic syndrome; (d) citrate production in prostaticcells is stimulated and finally, (e) the negative effects ofglucocorticoids on the immune system during stress arecounteracted [6].The appropriate treatment with dopamine agonists inpatients diagnosed with hyperprolactinemia have beenassociated with variable reduction in weight [1, 7], body fat[8], cardiovascular risk markers, cholesterol [1, 9–11], andendothelial dysfunction [1]. In patients with chronic kidney

Morbid obesity after spinal cord injury: an ailment not to be treated?

A 28-year-old man with a T12 incomplete paraplegia after a spinal cord injury (SCI) was referred for weight management in October 2011. He reported a weight gain from about 120 to 180.3 kg since his SCI. He put on a further 11.4 kg in January 2012 despite intensive dietetic treatment, including very low-caloric diet, anti obesity medication and active physiotherapy programme. He had undergone an uncomplicated laparoscopic Roux-en-Y gastric bypass successfully in March 2012. For the first 7 months after surgery, his total weight loss was 32.4 kg. He has shown functional improvement (6 min walking distance and Berg balance score). There were important improvements in body mass index; waist circumference; mid-upper arm circumference; triceps-skinfold thickness; mid-arm muscle circumference; total cholesterol; high-density lipoprotein-cholesterol; and low-density lipoprotein-cholesterol and triglycerides. This report describes the first UK morbidly obese SCI patient who has undergone gastric bypass surgery and highlights the provision of bariatric surgery as an option to consider if all nonsurgical interventions have been tried.

Randomized Controlled Trial Targeting Obesity-Related Behaviors: Better Together Healthy Caswell County

IntroductionCollaborative and multilevel interventions to effectively address obesity-related behaviors among rural communities with health disparities can be challenging, and traditional research approaches may be unsuitable. The primary objective of our 15-week randomized controlled pilot study, which was guided by community-based participatory research (CBPR) principles, was to determine the effectiveness of providing twice-weekly access to group fitness classes, with and without weekly nutrition and physical activity education sessions, in Caswell County, North Carolina, a rural region devoid of medical and physical activity resources.MethodsParticipants were randomly divided into 2 groups: group 1 was offered fitness sessions and education in healthful eating and physical activity; group 2 was offered fitness sessions only. Outcome measures were assessed at baseline and immediately after the intervention. Standardized assessment procedures, validated measures, and tests for analysis of variance were used.ResultsOf 91 enrolled participants, most were African American (62%) or female (91%). Groups were not significantly different at baseline. Group 1 experienced significantly greater improvements in body mass index (F = 15.0, P < .001) and waist circumference (F = 7.0, P = .01), compared with group 2. Both groups significantly increased weekly minutes of moderate physical activity (F = 9.4, P < .003). Participants in group 1 also had significantly greater weight loss with higher attendance at the education (F = 14.7, P < .001) and fitness sessions (F = 18.5, P < .001).ConclusionThis study offers effective programmatic strategies that can reduce weight and increase physical activity and demonstrates feasibility for a larger scale CBPR obesity trial targeting underserved residents affected by health disparities. This study also signifies successful collaboration among community and academic partners engaged in a CBPR coalition.